Health officials seeking ways to free up beds, cut care-home use

Some patients awaiting hospital stays are left sitting on stretchers as others occupy beds while they wait to move on. Photo Store

Patients waiting for spots in nursing homes, rehab and other placements are taxing Manitoba's hospitals, hogging close to 17 per cent of total bed time each year.

The repercussions are being felt throughout the hospital system, contributing to long emergency-room waits -- as patients lie on stretchers waiting for beds -- and even occasionally forcing doctors to postpone non-emergency surgeries.

3.4

percentage of hospitalizations involving patients awaiting admission to a personal care home or alternative form of care

16.7

percentage of bed days these patients occupied during the study period

26.6

percentage of patients admitted to hospital due to pregnancy and child birth

8.8

percentage of hospital bed days taken up by that group

3.9

percentage of patients hospitalized for mental disorders

9.5

percentage of hospital bed days taken up by patients with mental disorders

Health officials have long been aware of the problem and are working to minimize its effects. There are no quick fixes and the solutions are expensive.

But the seriousness of the issue was underscored Friday with the release of the most comprehensive review of Manitoba's 71 hospitals in at least a decade. The two-year study, using data from 2009 to 2011, examined how the province's 4,000 hospital beds are used -- the age, sex and sickness levels of patients, their length of stay and their socio-economic status.

'The conclusion is that the third leading cause of use of hospital days is people who... are waiting for another service to be set up'

-- lead researcher Randy Fransoo

One of the facts that leaps out of the Manitoba Centre for Health Policy's 342-page report is the vast amount of hospital bed time taken up by those who are waiting to go somewhere else.

The study found while such patients accounted for only 3.4 per cent of those admitted to hospital, their stays tended to be lengthy, accounting for 16.7 per cent of hospital bed days in Manitoba. Only surgical and medical patients (the latter category including heart and respiratory disease patients and those being treated for infections, etc.) occupied more bed time.

"Think about that -- the conclusion is that the third leading cause of use of hospital days is people who... are waiting for another service to be set up," said Randy Fransoo, the report's lead researcher.

In fact, more hospital bed time is taken up by this group in Manitoba each year than by all women giving birth.

The study found an average of 264 hospital beds were occupied by so-called alternative level of care or ALC patients -- 87 in Winnipeg and 177 outside the city. While there were fewer ALC patients in Winnipeg, their effect on city hospitals is likely much greater since these institutions deal with most of the trauma and extremely ill patients in the province.

(Although ALC patients include those awaiting home care, rehabilitation services and other placements, the vast majority of bed time is taken up by those waiting for placement in nursing homes.)

Lori Lamont, vice-president and chief nursing officer with the Winnipeg Regional Health Authority, said the region has set a goal of reducing the number of city hospital patients awaiting placement in personal care homes to 60. Right now, it's considerably higher, partly because late summer and early fall tend to be a time of high demand for care homes.

"The most recent report I saw, we have 100 people waiting for personal care home (placement) in Winnipeg hospitals right now," Lamont said.

The province has announced it will build two new personal care homes in Winnipeg in the next couple of years, adding a total of 200 beds. With an aging population, the demand for such homes will continue to grow, studies show.

More nursing-home capacity would mean shorter waits in hospitals for very ill seniors, but Lamont said officials do not want to prematurely direct patients to these institutions either. "If they don't really need to be there, that's not the best quality of life for the individual," she said.

Health officials are looking at alternatives to minimize personal care home use and free up hospital space. One idea that has potential is the creation of so-called hospital home teams to care for chronic high-needs patients in their homes. There are two such teams operating in Winnipeg already, and several more are planned. The teams consist of a doctor working in conjunction with a nurse or nurse practitioner and a home-care supervisor.

Meanwhile, the MCPH report, entitled Who is in our Hospitals... and Why?, found the top five per cent of hospital users -- those dramatically older and sicker than other hospital patients -- took up 45 per cent of all hospital days of care in the province. These 4,000 heavy users spent an average 114 days a year in hospital, compared with seven days for other hospital patients.

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